10. May 2014 · Comments Off on The Financial Case for EHR/RCM Integration The Power of Clinically Driven Revenue Cycle Management · Categories: Uncategorized

What is an EHR system?

An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care. EHRs can:
Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results
Allow access to evidence-based tools that providers can use to make decisions about a patient’s care
Automate and streamline provider workflow
One of the key features of an EHR is that health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization. EHRs are built to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.

What is an RCM system?

The revenue cycle management (RCM) system in the traditional sense is revenue generation function for a healthcare provider. It includes collection of revenue for the practice from insurance, posting of charges and rebilling in case of denials. Healthcare providers either have in house RCM or outsource it to billing companies that charge a percentage for collecting money from insurance companies.

Majority of the providers do not have these two systems integrated, when there are clear benefits gained by the practice if these two systems are tightly linked. The benefits of a true integration are given as follows.

• A rules-based engine can identify opportunities to optimize revenue streams directly at the point of clinical decision-making
• Alerts can advise when a requested procedure or test won’t be reimbursed by the payer, as well as flagging duplicative care
• Alternative procedures or tests for which the payer honors claims can be recommended over an initial, non-reimbursable choice
• As the rules-based engine grows over time, the system can recommend proven means for improving clinical and financial outcomes
• Electronic flow of data captured in the EHR directly into the RCM increases overall efficiency, accuracy and accountability
• When claims are still occasionally denied, faster and more accurate processing with rich clinical documentation supporting claims can speed up denial resolution
• Issues can be identified and resolved in the earliest stages of the revenue cycle, preventing recurrent errors later
• Reduction of errors and omissions at the point of clinical decision-making increases overall revenue capture
• Clinical — More informed decision-making at the point of care can lead to improved clinical outcomes and health management
• Financial — Consumers are far less likely to face hefty and unexpected out-of-pocket costs for tests or procedures not covered by their insurance plans
• Satisfaction and consumer engagement — Having the combination of clinical and financial data at the time the caregiver is engaging with the patient leads to a better dialog regarding options, engaging the consumer more directly in care and achieving a higher level of satisfaction with the healthcare encounter and provider

True integration

What is meant by true integration? True integration is achieved when both systems share data at the database level i.e. they share the same database. They should be passing and saving information in the unique patient records efficiently and effectively.

ICD 9 to ICD 10 Conversion

The advent of ICD 10 has proven to be a challenge for healthcare providers with unintegrated EHR and RCM systems for the following reasons.
1) The conversion will increase cost in new software updates
2) Increase costs in physician and staff training
As a result it is expected that to advert these costs, 30% of healthcare providers will render the services of billing companies and thus outsource the RCM function of the practice. The question remains is that will the outsourcing give the same kind of data integrity and benefits enjoyed by an integrated RCM/EHR system?


I believe that integrated RCM/EHR solutions would be essential for all healthcare providers, as it reduces human intervention and thus human error. The Integrated RCM/EHR system is efficient. Let us analyze the workflow for a traditional practice. The doctor sees a patient makes a record of diagnosis, the back staff generates a super bill that is either taken to a biller in-house or to an outsourced billing service who bill the insurance companies. The integrated RCM/EHR system would eliminate all these steps and human intervention. The work flow of a truly integrated system would be the doctor filling in the diagnosis for the patient which the program will automatically save in the patient record and charge their insurance company. Hence it is essential for healthcare providers to have an integrated RCM/EHR system.

Reference: Greenway • WHITE PAPER: Clinically Driven RCM

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